Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases

Ikemura, Satoshi; Mawatari, Taro; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiromichi

doi:10.1259/bjr.20150750

Cited by 11 publications

(14 citation statements)

References 16 publications

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“…The findings of this study showed that bone metabolic markers and the length of band patterns were associated with the changes in JSW, suggesting that these parameters could be the predictors of poor progression in patients with SIF. The MRI findings of this study were consistent with those of previous reports regarding the association of clinical outcome and MRI [16,25], suggesting that MRI findings, including the length of band pattern and location of intensity change at the time of diagnosis, could be a prognostic predictor as well as a highly sensitive investigation for SIF. In addition, serum P1NP…”

Section: Discussionsupporting

confidence: 91%

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Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Shimizu

Yokota

Kimura

et al. 2020

Preprint

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Background There is evidence that the cause of primary osteoarthritis (OA) is related to the changes in subchondral bone; however, it is not fully understood if subchondral insufficiency fracture (SIF) of the femoral head would affect degeneration of the hip joint and what the prognostic factors related to joint degeneration are. The objectives of this study were 1) to investigate the longitudinal joint space narrowing and 2) to investigate the associations between joint space narrowing and bone metabolic markers as well as magnetic resonance imaging (MRI) among the patients with SIF. Methods Between January 2010 and December 2019, 238 patients in whom band pattern of the femoral head were observed on MRI visited our hospital. Among these patients, 44 hips in 41 patients were diagnosed with SIF and eligible for this retrospective study. We evaluated the joint space width (JSW) of the hip on the radiograph obtained at the first and last visits, length of the band lesion on MRI, bone mineral density by dual-energy x-ray absorptiometry, and bone metabolism markers. We investigated the factors associated with the necessity of surgery and the progression of the narrowing of the joint space. Results Fifteen of the 44 hips required total hip arthroplasty (THA). The JSW showed a significant decrease from the first visit to the final follow-up. Changes in the JSW were associated with the length of band patterns, serum type 1 procollagen-N-propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b) at the date of diagnosis. Additionally, bone metabolic markers tended to be associated with the length of the band pattern. Conclusions SIF could cause joint space narrowing and hip OA. In addition to MRI findings as prognostic predictors of SIF, as previously described, bone metabolic markers were also associated with changes in JSW, suggesting that these parameters could be useful to predict the prognosis of SIF. Considering that bone metabolic markers trended to be associated with the length of band pattern, they might reflect the local severity.

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Section: Discussionsupporting

confidence: 91%

“…Among those diagnosed with SIF, patients who could be diagnosed within 3 months after hip pain were supervised to avoid weight-bearing with crutches for 6 weeks [25] and were treated on an outpatient basis every 2 weeks. Patients with late diagnosis or poor compliance could not be treated with conservative therapy as an initial treatment.…”

Section: Methodsmentioning

confidence: 99%

Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Shimizu

Yokota

Kimura

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The study ndings showed that bone metabolic markers and thelength of band patterns were associated with the changes in JSW,suggesting that these parameters could be predictors of poorprogression in patients with SIF. The MRI ndings of this studywere consistent with those of previous reports regarding theassociation of clinical outcome and MRI [16,25], suggesting thatMRI ndings, including the length of band pattern and location o ntensity change during diagnosis, could be prognostic predictorsas well as highly sensitive indicators for SIF investigation. Inaddition, serum P1NP and TRACP-5b were associated with joint spacenarrowing, suggesting that the levels of bone metabolic markersmight be predictors for OA among patients with SIF.…”

Section: Discussionsupporting

confidence: 90%

“…Among those diagnosed with SIF, patients who could be diagnosedwithin 3 months after hip pain were supervised to avoidweight-bearing with crutches for 6 weeks [25] and were treated on an outpatient basis every2 weeks. Patients with late diagnosis or poor compliance could notbe initially treated with conservative therapy.…”

Section: Methodsmentioning

confidence: 99%

Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Shimizu

Yokota

Kimura

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: There is evidence that the cause of primary osteoarthritis (OA) is related to the changes in subchondral bone; however, the influence of subchondral insufficiency fracture (SIF) of the femoral head on the degeneration of the hip joint and the prognostic factors related to joint degeneration remain unclear. The objectives of this study were: 1) to investigate the natural history of joint space width after the occurrence of SIF and 2) to investigate the associations between joint space narrowing and bone metabolic markers as well as magnetic resonance imaging (MRI) among the patients with SIF.Methods: Between January 2010 and December 2019, 238 patients in whom band pattern of the femoral head were observed on MRI visited our hospital. Among these patients, 44 hips in 41 patients were diagnosed with SIF and eligible for this retrospective study. We evaluated the joint space width (JSW) of the hip on the radiograph obtained at the first and last visits, length of the band lesion on MRI, bone mineral density by dual-energy x-ray absorptiometry, and bone metabolism markers. Similarly, the factors associated with the necessity of surgery and the progression of the narrowing of the joint space were evaluated.Results: Fifteen of the 44 hips required total hip arthroplasty (THA). A significant decrease was observed in the JSW from the first visit to the final follow-up. Changes in the JSW were associated with the length of band patterns, serum type 1 procollagen-N-propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b) during diagnosis. Additionally, bone metabolic markers tended to be associated with the length of the band pattern. Conclusions: SIF could cause joint space narrowing and hip OA. In addition to MRI findings as prognostic predictors of SIF, as previously described, bone metabolic markers were equally associated with changes in JSW, suggesting that these parameters could be useful in predicting the prognosis of SIF. Considering that bone metabolic markers trended to be associated with the length of band pattern, they might reflect the local severity.

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“…Several studies have shown that some of SIFFH patients can be managed by non-surgical treatment with survival rate from about 40 to 50% with a high (50–60%) THA conversion rate [6, 9, 14]. …”

Section: Discussionmentioning

confidence: 99%

Hip arthroscopy enables classification and treatment of precollapse subchondral insufficiency fracture of the femoral head associated intra-articular pathology

Uchida

Noguchi

Utsunomiya

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purposes of this study were to investigate (1) the clinical, radiographic and arthroscopic presentation of patients with subchondral insufficiency fracture of the femoral head (SIFFH) and (2) the outcomes following arthroscopic treatment with internal fixation using hydroxyapatite poly-lactate acid (HA/PLLA) threaded pins and concomitant arthroscopic treatment of associated findings.MethodsNine patients (median age 49.0 years, range 43–65, five female and four male patients) with SIFFH who underwent arthroscopic treatment with labral repair, capsular closure and internal fixation of SIFFH using HA/PLLA pins were retrospectively reviewed. Inclusion criteria were adult patients with precollapse SIFFH with minimum 1-year follow-up (median follow-up 30.0 months, range 12–56).ResultsAcetabular labral tears were observed in all patients. The median BMI was 24.3 kg/m2 (range 20.1–31.8). Clinical presentations and radiographic measurements demonstrated mixed type FAI in six patients, borderline developmental dysplasia in two patients and pincer type FAI in one patient. The median MHHS significantly improved from preoperatively (67.1, range 36.3–78.0) to post-operatively (96.8, range 82.5–100; p = 0.001). The median NAHS significantly improved from preoperatively (34.0, range 17–63) to post-operatively (78.0 range 61–80; p = 0.001).ConclusionSIFFH is associated with bony deformities and labral tears. Precollapse SIFFH can be treated with bioabsorbable pin stabilization of unstable lesions and treatment of associated intra-capsular pathology in those with stable lesions as determined by a new arthroscopic classification system with promising early outcomes.Level of EvidenceIV.

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Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases

Cited by 11 publications

References 16 publications

Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Hip arthroscopy enables classification and treatment of precollapse subchondral insufficiency fracture of the femoral head associated intra-articular pathology

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